Healthcare Provider Details

I. General information

NPI: 1922579507
Provider Name (Legal Business Name): KENDALL DAVIS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2018
Last Update Date: 05/24/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 S DOBSON RD STE 200
MESA AZ
85202-6412
US

IV. Provider business mailing address

2089 N SUNSET DR
CHANDLER AZ
85225-2943
US

V. Phone/Fax

Practice location:
  • Phone: 602-686-0346
  • Fax:
Mailing address:
  • Phone: 602-686-0346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-47939
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: